Provider Demographics
NPI:1669857876
Name:NORTHWEST TRI-COUNTY INTERMEDIATE UNIT # 5
Entity Type:Organization
Organization Name:NORTHWEST TRI-COUNTY INTERMEDIATE UNIT # 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:814-734-8401
Mailing Address - Street 1:252 WATERFORD STREET
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-2315
Mailing Address - Country:US
Mailing Address - Phone:814-734-5610
Mailing Address - Fax:814-734-5806
Practice Address - Street 1:252 WATERFORD STREET
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-2315
Practice Address - Country:US
Practice Address - Phone:814-734-5610
Practice Address - Fax:814-734-5806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST TRI-COUNTY INTERMEDIATE UNIT 5
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-29
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency